Controversies to Take Center Stage at CSF

It’s that time of year again, and with new and returning faculty, controversial and timely topics, and an all new venue, this year’s Cosmetic Surgery Forum (CSF) is slated to be the biggest and best yet.

Taking place at Las Vegas’ chic Cosmopolitan Hotel, the meeting will feature 50 sessions and a robust exhibit floor for what will be the Forum’s last hurrah in Vegas for the time being. CSF will relocate to Nashville in 2019 for the ensuing four years.

The FDA on Vaginal Rejuvenation

“We are aware that certain device manufacturers may be marketing their energy-based medical device for vaginal ‘rejuvenation’ and/or cosmetic vaginal procedures. The safety and effectiveness of energy-based medical devices to perform these procedures has not been established.

Vaginal ‘rejuvenation’ is an ill-defined term; however, it is sometimes used to describe non-surgical procedures intended to treat vaginal symptoms and/or conditions including, but not limited to:

• Vaginal laxity

• Vaginal atrophy, dryness, or itching

• Pain during sexual intercourse

• Pain during urination

• Decreased sexual sensation

To date, we have not cleared or approved for marketing any energy-based devices to treat these symptoms or conditions, or any symptoms related to menopause, urinary incontinence, or sexual function. The treatment of these symptoms or conditions by applying energy-based therapies to the vagina may lead to serious adverse events, including vaginal burns, scarring, pain during sexual intercourse, and recurring/chronic pain.”

Known as the meeting where experts are not afraid to say what they really think about a technology, procedure, or trend, this year’s Cosmetic Surgery Forum will not shy away from controversy. For example, members of the 2018 faculty will take on the growing use of lasers and other energy-based devices for female rejuvenation. The FDA recently came out swinging against these procedures and the doctors who perform them, citing that none of the devices used for internal application have been cleared or approved for treating symptoms related to menopause, urinary incontinence, or sexual function. Further, the FDA stated that the treatment of these symptoms or conditions with energy-based therapies may lead to serious adverse events, including vaginal burns, scarring, pain during sexual intercourse, and recurring/chronic pain (See Sidebar).

Is the agency on point or is there a middle ground? Are we denying needed treatments to a substantial proportion of the population? These are questions posed by CSF founder and director Joel Schlessinger, MD, a dermatologist and general cosmetic surgeon in Omaha, NE, the Owner & CEO of LovelySkin.com, and founder of the Advanced Skin Research Center.

“So many practitioners are getting into this field with questionable credentials, and they are significantly overstating the results,” he says. “On the other hand, many respected colleagues find value in these treatments. There has to be an answer out there!”

CSF participants, including San Diego-based dermatologist Sabrina Guillen Fabi, MD, will discuss the pros and the cons of energy-based vaginal rejuvenation. “There is a huge interest in this field, and it’s important to get it right coming out of the gate or we will have unhappy, dissatisfied patients as well as patients who are harmed during the procedures,” Dr. Schessinger says.

Dr. Fabi will share results of her feminine rejuvenation study using ThermiVA. “We found an increase in nerve density and thickness in the tissue that we treated, which is probably the reason why there was a high patient satisfaction rate,” she says.

Erectile Rejuvenation

Speaking of below-the-belt procedures, David J. Goldberg, MD, JD, Director of Skin Laser & Surgery Specialists of New York and New Jersey, is slated to present on shockwave therapy for men who have vascular-induced erectile dysfunction (ED).

“Shockwave therapy is simply one more form of electromagnetic radiation in a line from lasers to light sources to radiofrequency to microwave to ultrasound,” Dr. Goldberg explains. “High-intensity shockwave therapy is used to dislodge kidney stones. Low-intensity radial shockwave therapy induces microtrauma and is FDA cleared for the treatment of cellulite.” This same microtrauma also induces the development of small vessels in the treatment area, he says. “There is now ample urologic evidence that the use of low-intensity radial shockwave therapy in the treatment of men who have vascular-induced erectile dysfunction can lead to dramatic improvement in sexual function,” Dr. Goldberg says. “This improvement can be seen both in men who respond to or who fail oral erectile dysfunction agents.”

This year’s key note is on humor in medicine and will be given by Elk Grove, IL dermatologist Michael Greenberg, MD, who is also a founder of an improv troupe called The Waiting Room. Dr. Greenberg will regale the crowd with tips on how to utilize humor to improve patient interactions.

Sunscreen update

As skin cancer prevalence continues to rise, the importance of sun protection, including sunscreen use, has become accepted in the public. Hawaii has recently banned the use of the two most common organic filters, oxybenzone and octinoxate, due to reports of potential harmful effect on the coral reefs.

See higlights from CSF 2017 and hear first-hand from presenters and attendees at DermTube.com.

“I will discuss recent studies about these specific filters related to the adverse health risks they purportedly pose for humans and other marine organisms,” says CSF faculty member Edit B. Olasz Harken, MD, PhD, a dermatologist in Milwaukee, WI.

Last year Bexley, Ohio-based dermatologist Matt Zirwas, MD wowed the crowd with several talks including one on how our judicious use of certain sunscreens may be harming our coral supply, and this year Dr. Zirwas takes on the growing category of longevity supplements and whether they really work.

A Perfect 10?

Heading into its tenth year, CSF is poised to provide education and insight to attendees. In addition to the offering of lectures from the podium, the meeting once again offers treatment demonstrations.

“It’s going to be a great year and, as always, it isn’t ever the same conference due to the audience participation and discussion that goes in different tangents,” promises Dr. Schlessinger.

Cosmetic Surgery Forum 2018 will be held November 28 to December 1 at Cosmopolitan, Las Vegas. Information is available at cosmeticsurgeryforum.com.

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About Practical Dermatology

Practical Dermatology is the monthly publication that provides coverage of medical care, cosmetic advancements, and practice management for clinicians in the field. With straight-forward, how-to advice from experts in various fields, we strive to enhance quality of care and improve the daily operation of dermatology practices.

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